|
HC CATHETER INTRADISCAL
|
Facility
|
IP
|
$1,532.09
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.22 |
| Max. Negotiated Rate |
$1,378.88 |
| Rate for Payer: Aetna Commercial |
$1,302.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.86
|
| Rate for Payer: Cash Price |
$1,225.67
|
| Rate for Payer: Cofinity Commercial |
$1,072.46
|
| Rate for Payer: Cofinity Commercial |
$1,317.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,072.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.67
|
| Rate for Payer: Healthscope Commercial |
$1,378.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,302.28
|
| Rate for Payer: PHP Commercial |
$1,302.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.86
|
| Rate for Payer: Priority Health SBD |
$965.22
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.01 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health SBD |
$19.01
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$27.27 |
| Rate for Payer: Aetna Commercial |
$25.64
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.36
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$25.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Mclaren Medicaid |
$4.87
|
| Rate for Payer: Mclaren Medicare |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$27.27
|
| Rate for Payer: PACE Medicare |
$8.64
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PHP Commercial |
$25.64
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.83
|
| Rate for Payer: Priority Health Medicare |
$9.09
|
| Rate for Payer: Priority Health Narrow Network |
$7.06
|
| Rate for Payer: Priority Health SBD |
$19.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UHCCP Medicaid |
$5.12
|
| Rate for Payer: VA VA |
$9.09
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna Medicare |
$33.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health SBD |
$42.41
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.76
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$47.12
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health SBD |
$42.41
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.91 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.05
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$249.90
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health SBD |
$224.91
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.05
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$249.90
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.60
|
| Rate for Payer: Healthscope Commercial |
$321.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.45
|
| Rate for Payer: PHP Commercial |
$303.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health SBD |
$224.91
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
OP
|
$11,857.50
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna Medicare |
$5,928.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,173.84
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
IP
|
$11,857.50
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,470.22 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.22
|
|
|
HC CATHETER SINGLE
|
Facility
|
IP
|
$190.56
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna Commercial |
$161.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.86
|
| Rate for Payer: Cash Price |
$152.45
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Commercial |
$163.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.45
|
| Rate for Payer: Healthscope Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.98
|
| Rate for Payer: PHP Commercial |
$161.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.86
|
| Rate for Payer: Priority Health SBD |
$120.05
|
|
|
HC CATHETER SINGLE
|
Facility
|
OP
|
$190.56
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Aetna Commercial |
$161.98
|
| Rate for Payer: Aetna Medicare |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.86
|
| Rate for Payer: BCBS Complete |
$76.22
|
| Rate for Payer: Cash Price |
$152.45
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Commercial |
$163.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.45
|
| Rate for Payer: Healthscope Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.98
|
| Rate for Payer: PHP Commercial |
$161.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.86
|
| Rate for Payer: Priority Health SBD |
$120.05
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
IP
|
$1,638.63
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.34 |
| Max. Negotiated Rate |
$1,474.77 |
| Rate for Payer: Aetna Commercial |
$1,392.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.11
|
| Rate for Payer: Cash Price |
$1,310.90
|
| Rate for Payer: Cofinity Commercial |
$1,147.04
|
| Rate for Payer: Cofinity Commercial |
$1,409.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,310.90
|
| Rate for Payer: Healthscope Commercial |
$1,474.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.84
|
| Rate for Payer: PHP Commercial |
$1,392.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.11
|
| Rate for Payer: Priority Health SBD |
$1,032.34
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
OP
|
$1,638.63
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$655.45 |
| Max. Negotiated Rate |
$1,474.77 |
| Rate for Payer: Aetna Commercial |
$1,392.84
|
| Rate for Payer: Aetna Medicare |
$819.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.11
|
| Rate for Payer: BCBS Complete |
$655.45
|
| Rate for Payer: Cash Price |
$1,310.90
|
| Rate for Payer: Cofinity Commercial |
$1,147.04
|
| Rate for Payer: Cofinity Commercial |
$1,409.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,147.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,310.90
|
| Rate for Payer: Healthscope Commercial |
$1,474.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.84
|
| Rate for Payer: PHP Commercial |
$1,392.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.11
|
| Rate for Payer: Priority Health SBD |
$1,032.34
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
IP
|
$7,696.07
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,848.52 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
OP
|
$7,696.07
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna Medicare |
$3,848.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: BCBS Complete |
$3,078.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
IP
|
$9,710.40
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,117.55 |
| Max. Negotiated Rate |
$8,739.36 |
| Rate for Payer: Aetna Commercial |
$8,253.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.76
|
| Rate for Payer: Cash Price |
$7,768.32
|
| Rate for Payer: Cofinity Commercial |
$6,797.28
|
| Rate for Payer: Cofinity Commercial |
$8,350.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.32
|
| Rate for Payer: Healthscope Commercial |
$8,739.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.84
|
| Rate for Payer: PHP Commercial |
$8,253.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.76
|
| Rate for Payer: Priority Health SBD |
$6,117.55
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
OP
|
$9,710.40
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.06 |
| Max. Negotiated Rate |
$8,739.36 |
| Rate for Payer: Aetna Commercial |
$8,253.84
|
| Rate for Payer: Aetna Medicare |
$4,855.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.76
|
| Rate for Payer: BCBS Complete |
$3,884.16
|
| Rate for Payer: Cash Price |
$7,768.32
|
| Rate for Payer: Cofinity Commercial |
$6,797.28
|
| Rate for Payer: Cofinity Commercial |
$8,350.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.32
|
| Rate for Payer: Healthscope Commercial |
$8,739.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.84
|
| Rate for Payer: PHP Commercial |
$8,253.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.76
|
| Rate for Payer: Priority Health SBD |
$6,117.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,418.06
|
|
|
HC CATH LAB STANDBY
|
Facility
|
IP
|
$499.71
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$314.82 |
| Max. Negotiated Rate |
$449.74 |
| Rate for Payer: Aetna Commercial |
$424.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.81
|
| Rate for Payer: Cash Price |
$399.77
|
| Rate for Payer: Cofinity Commercial |
$349.80
|
| Rate for Payer: Cofinity Commercial |
$429.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.77
|
| Rate for Payer: Healthscope Commercial |
$449.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.75
|
| Rate for Payer: PHP Commercial |
$424.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.81
|
| Rate for Payer: Priority Health SBD |
$314.82
|
|
|
HC CATH LAB STANDBY
|
Facility
|
OP
|
$499.71
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.88 |
| Max. Negotiated Rate |
$449.74 |
| Rate for Payer: Aetna Commercial |
$424.75
|
| Rate for Payer: Aetna Medicare |
$249.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.81
|
| Rate for Payer: BCBS Complete |
$199.88
|
| Rate for Payer: Cash Price |
$399.77
|
| Rate for Payer: Cofinity Commercial |
$349.80
|
| Rate for Payer: Cofinity Commercial |
$429.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.77
|
| Rate for Payer: Healthscope Commercial |
$449.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.75
|
| Rate for Payer: PHP Commercial |
$424.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.81
|
| Rate for Payer: Priority Health SBD |
$314.82
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna Medicare |
$367.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health SBD |
$462.67
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.67 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health SBD |
$462.67
|
|
|
HC CAT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC CAT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
